ACCIDENT INSURANCE
COVERAGE
(STANDARD INSURANCE)
MEDICAL INSURANCE REIMBURSEMENT
(STANDARD INSURANCE CLAIM)
REQUIREMENTS
1. Incident Report / Police Report
2. Photocopy of 2 valid IDs
(3 signatures beside the image)
3. Official Receipts (OR) - Original copy
(purchase of medicines, doctor's fee and
hospital payments)
4. Medical Certificate (original copy)
5. Doctor's prescriptions
6. Laboratory results, if any
PROCESS
•Kapag naaksidente ang miyembro, pumunta sa malapit na ospital at pasabihan ang Coordinator.
•Ang Coordinator ay mag submit ng Spot Report (What, When, Where, Who, Status) sa Viber account ng Sakay Tulong Center. ***Iwasan magpadala ng pictures sa Group Chat
•Kasama sa Spot Report ng Coordinator ang INITIAL Assessment mula sa ospital, depende sa medical emergency need ng miyembro. ***Mahalaga ang assessment na ito.
•Pagkalabas ng ospital, lahat ng Official Receipts (ORIGINAL) at iba pang requirements ay dapat ibigay sa Sakay Cooperative para sa Insurance Medical Reimbursement Claims of Standard Insurance.
•Ang approved amount ay manggagaling sa Standard Insurance base sa na-submit na mga dokumento. Mula sa approved amount, ikakaltas ng Sakay ang naibigay na CA sa miyembro noong naospital siya.
PA EXCLUSION LIST CLAUSE
War invasion, Act of Enemy, Rebellion, Insurrection, Terrorism, Mutiny Crowd disturbancesm,
Military or Usurped Power or Popular Uprising, Riot, Strike and Civil Commotion.
Intentionally self-inflicted injuries, Suicide or Attempted suicide, while sane or insane; Alcoholism or under the influence of alcohol, drug addiction; HIV, AIDS, STD annd venereal diseases.
Earthquake, Volvanic Eruption or Tidal Wave
Whlist the insured is traveling in an aircraft other than once licensed for public passenger service and operated by a regular Airline on published scheduled flight...
Consequent upon the insured engaging in hunting, racing of all kinds, steeple chasing, polo playing, motorcycle riding or driving, trekking/climbing and mountaineering, winter sports, ice hockey, football, yachting, or using woodworking machinery driven by mechanical power, scuba diving and other offshore activities, mountain biking, off road biking, parachuting, hang-gliding.
Murder and Assault or any attempt threat;
Caused directly or indirectly by the bad faith of the Insured, by his/her participation in criminal acts, or as a result of his/her fraudulent, seriously negligent or reckless actions.
Whilst engaging in military duty; Illegal acts or violence of the war,
Whilst the insured takes part in bets, challenges, or brawls, save in the case of legitimate defense
Activities engaged in any duty directly or indirectly pertaining to the ff: occupations; Aviator, Steward/ess, individual connected with the military and police, missionaries, miners and underground workers, individual involved in the manufacturing processing of nuclear materials and explosives, individual with constant contact with hazardous chemicals, individuals connected with politics, detective, bodyguards, bullfighters, divers, equestrians and jockeys, firemen, fishermen, fishing crew and any offshore activities/trainings, logging workers, circus workers, stuntmen, quarry workers, loggers, sawmill workers, racers, sailors and window cleaners of a high rise buildings;
Any pre existing conditions; Pre-exesting conditions are illnesses or injury for which the person has been under the care of a physician and has received medical care or advice or a condition for which a reasonable person should have sought treatment;
Congenital anomalies and conditions;
Insect/mosquitos bites
Pregnancy, childbirth and miscarriege or any related conditions with respect to woman;
Any Rehabilitation treatments, Prostheses, Orthopedic material or orhesis and osteosynthesis matrial, as well as spectacles are not covered;
HOSPITAL CONFINEMENT FOR:
Rest cures, Periodic check ups, Cosmetic or plastic surgery, Any dental work, dental treatment or eye examination except as result of bodily injury, Mental or nervous disorders
